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* From the Cedars-Sinai Medical Center, Los Angeles, CA.
Correspondence to: Dani Hackner, MD, Division of Pulmonary & Critical Care Medicine, ROOM 6732, Cedars-Sinai Medical Center, Los Angeles, CA 90048; e-mail: hackner{at}zynx.com
Background: We studied patients of a hospitalist teaching service and patients receiving routine private care (control subjects). We sought to evaluate whether inpatients cared for by an academic hospitalist service had lower lengths of stay and resource utilization rates.
Methods: Using monthly hospital census data, 477 hospitalist cases and 1,160 control cases were selected by explicit criteria from the Medicaid population of a large, university-affiliated, community medical center between July 1, 1996, and June 30, 1997. Outcomes in hospitalist faculty patients were compared to those of control patients under the care of private providers.
Results: Median length of stay was 4 days
for control subjects and 3 days for the hospitalist service
(p < 0.0001). Median total cost per case was $4,853 for control
subjects and $4,002 for hospitalist patients (p < 0.0001). Only
patients 
65 years old showed statistically significant reductions
in both length of stay (p < 0.0001) and total cost (p = 0.002).
Subspecialty consultation rates were 37.6% for control subjects and
16.6% for hospitalist cases (p < 0.0001). We noted increasing
consultations for patients 65 years old, especially in the control
group (p = 0.001). No significant differences in mortality, 30-day
readmissions, or interfacility transfers were observed.
Conclusions: Patients cared for by an academic
hospitalist service that includes actively participating medical
residents appear to have lower lengths of stay, total costs, and
consultation rates than patients receiving routine private care. The
reductions are largely observed among patients 65 years
old.
Key Words: cost • efficiency • hospitalist • inpatient • internal medicine • length of stay • Medicaid • Medicare • Medi-Cal • outcome • residents • teaching
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